期刊论文详细信息
Frontiers in Neurology
Bubble Test and Carotid Ultrasound to Guide Indication of Transesophageal Echocardiography in Young Patients With Stroke
Sebastian Grundmann1  Alexander Asmussen1  Brigitte Guschlbauer2  Christoph Strecker2  Andreas Harloff2  Dirk Kanz2  Christopher D. Anderson3  Ernst Mayerhofer4 
[1] Department of Cardiology and Angiology I Heart Center, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany;Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany;Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States;Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;
关键词: ischemic stroke;    transient ischemic attack;    diagnostic imaging;    ultrasound;    bubble test method;    carotid intima-media thickness;   
DOI  :  10.3389/fneur.2022.836609
来源: DOAJ
【 摘 要 】

Background and PurposeIndication of transesophageal echocardiography (TEE) in patients ≤60 years with brain ischemia is uncertain.MethodsThis prospective double-blinded study included patients with cryptogenic acute ischemic stroke or transient ischemic attack (TIA) ≥18 and ≤60 years. After routine diagnostics, all patients underwent patent foramen ovale (PFO) screening by transcranial Doppler (TCD) bubble test, carotid ultrasound for atherosclerosis screening (intima-media-thickness >0.90 mm or plaques), and TEE. We calculated sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the combined non-invasive ultrasound to predict therapy-relevant TEE findings.ResultsWe included 240 consecutive patients (median 51 years, 39% women) of which 68 (28.3%) had both a negative bubble test and no carotid atherosclerosis. Of these, 66 (97.1%) had unremarkable TEE findings; in one patient a small PFO was found and closed subsequently, in another patient a 4.9 mm thick aortic atheroma was found, and double platelet inhibition initiated. Of the other 172 (71.7%) patients, 93 (54%) had PFO and 9 (5.2%) complex aortic plaques. No other therapy-relevant findings were present in both groups. Non-invasive ultrasound had a sensitivity of 98.0%, specificity of 47.8%, NPV of 97.1%, and PPV of 58.1% for therapy-relevant TEE findings.ConclusionsBubble test and carotid ultrasound could be used for the individual decision for/against TEE in patients with cryptogenic stroke ≤60 years. If they are unremarkable, TEE can be omitted with high safety regarding secondary prevention. If bubble test is positive and/or carotid ultrasound shows atherosclerosis, TEE should be carried out if PFO or aortic atheroma are potentially relevant for further patient management.

【 授权许可】

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